September 29, 2015
COPD Core Measure Monitoring at Discharge (including PHPCP and DEx)
Enhancements for Nutrition Orders for Discharge
COPD Core Measure Monitoring at Discharge
To comply with the redesigned guidelines for care of patients with COPD, discharge orders have been updated to include core monitoring documentation for clinicians. These core measures are based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Criteria for COPD Management. Enhancements have been made to Core Measures in the discharge orders, the Post Hospital Patient Care Plan (PHPCP) in discharge instructions, and the Discharge Instructions and Plans for Follow-up section of the DEx discharge summary.
Key features:
Core measure monitoring for chronic obstructive pulmonary disease (COPD) is required for all adult patients who are discharged with one or more defined diagnoses. The initial question is "Was the patient admitted due to COPD exacerbation or COPD related condition?"
Depending on the diagnosis itself, and whether it is principal or associated, the initial question is either answered Yes by default and cannot be changed, or requires the ordering provider to select a Yes or No answer. See the COPD core measures matrix.
If the first question is answered Yes, you must answer the remaining questions. In addition, the discharging nurse is required to document on the Post Hospital Patient Care Plan (PHPCP) whether the patient has received COPD Success Tracker and MGH COPD Education sheet.
Evidence-based management of COPD includes discharging the patient with an order for a long-acting bronchodilator. The discharging provider must answer whether an applicable medication has been or will be ordered, and if not, provide the reason.
The discharging provider must document whether the
patient ever had pulmonary function tests (PFT) performed. Answering
No or Unknown inserts the following into the Discharge Instructions
and Plans for Follow-up section of DEx:
COPD: Based on clinical impression,
the patient may have COPD but has no known Pulmonary Function Testing
in the past. It is recommended that pulmonary function testing
(consider full testing, spirometry with bronchodilators at a minimum)
be scheduled for this patient as an outpatient.
The discharging provider must document whether the patient has been or will be scheduled for pulmonary rehabilitation as an outpatient. Clicking the link beneath the rehab question displays a list of pulmonary rehabilitation programs for outpatients offered in the state of Massachusetts. You can print it for the patient to decide the most suitable option.
The discharging provider is prompted to reconsider when indicating that outpatient rehab is not planned. The prompt includes a button to order outpatient pulmonary rehab that opens the discharge Services folder; clicking the button for the list displays a list of pulmonary rehabilitation programs for outpatients offered in the state of Massachusetts; canceling closes the prompt. See Writing Orders for Services at Discharge.
Message for discharging providers: Monitoring COPD Core Measures (from the Center for Quality and Safety)
Instructions: Monitoring Core Measures on Discharge
Enhancements for Nutrition Orders for Discharge
The discharge orders for nutrition have been enhanced to facilitate interdisciplinary communication and remove unnecessary or redundant information. In addition, when the orders indicate the need, the provider who signs the discharge orders as final is prompted to complete a referral for outpatient follow-up for nutrition.
Key features:
The current active inpatient orders for Food and Nutrition Services are displayed when available.
Fields for possible completion are the discharge diet recommendation from the patient's MGH dietician; TPN for pediatric patients; formula recipes; nutrition discharge summary; nutrition plan and/or recommendations for follow-up; referral reason for outpatient nutrition follow-up.
When the discharging provider saves the orders as final, and an option is selected for the Referral Reason for Outpatient Nutrition Follow-up, the provider is prompted to print and complete the referral form.
Instructions:
See also: